Vol 28, No 11 (2021)

General principles for evaluating the effectiveness of anticancer treatment in oncology. RECIST criteria: Based on various instrumental methods for assessing tumor foci in general oncology, the standard RECIST 2009 criteria (RECIST 1.1) for evaluating solid tumors are used to assess tumor dynamics. These criteria are used in computed tomography and magnetic resonance imaging and, in some cases, in conventional radiography. In neurooncology, both in clinical trials and in routine clinical practice, RANO criteria rather than RECIST and Macdonald criteria should be used due to the specific anatomy and biological behavior of CNS tumors, as well as the features of neuro-imaging against the background of anticancer drug therapy and modern methods of radiation therapy. Based on the experience of the application of the Response evaluation criteria in solid tumors (RECIST) criteria and the McDonald criteria, RANO-HGG includes among the parameters for evaluating MRI in the T1 mode with contrast enhancement and T2/FLAIR modes, the use of corticosteroids, as well as the dynamics of clinical status; defines the concept of «pseudo-progression» and «pseudo-response to treatment», which have become relevant in the era of modern methods of radiation therapy and anti-angiogenic and other drugs that affect vascular permeability. RANO criteria for low-grade gliomas: MR semiotics is similar to other processes such as demyelination or ischemia; in addition, the slow growth characteristic of these tumors often complicates the assessment of the disease response, therefore the concept of «low response to treatment» was introduced (reduction in the size of the measured foci by 25-50%). RANO criteria for metastatic lesions of the central nervous system (brain metastases) and RANO criteria for leptomeningeal metastasis: The purpose of RANO-BM is to determine the activity of potential agents against brain metastases and to determine the appropriate endpoints for clinical trials; it is important that these criteria are needed for a more accurate assessment of events with intracranial foci than in the RECIST system, according to which the diameters of intracerebral tumor foci should be summed up with the diameters of both the main tumor and distant metastatic foci. RANO criteria for immunotherapy - iRANO: their development was attributable to the specific reactions to immunotherapy - an increase in the area of brain edema against the background of the onset of immunotherapy; this scoring system makes it possible to consistently and logically differentiate the tumor response to treatment from tumor progression; leptomeningeal metastasis is a dangerous and late complication of a disseminated oncological process with damage to the central nervous system, most often found in breast and lung cancer, as well as in hematological malignant neoplasms. Neurological Assessment in Neurooncology: although the Macdonald and RANO criteria include clinical status in the definition of progression, there is no quantitative measure to its determination. To address this limitation and quantify clinical outcomes, the Neurological Assessment in Neuro-Oncology (NANO) was created. RANO-corticosteroids: corticosteroids in various doses are an integral part of the clinical management of patients with CNS tumors at various stages of treatment; however, it has been suggested that patients requiring steroids for longer periods of time or at higher doses have a shorter overall survival. In addition, steroid use, along with age and work performance, was associated with a poor prognosis. RANO-PET/CT: The latest revision of these RANO/PET group recommendations was published in 2019. In 2017, recommendations for the use of PET/CT with amino acid tracers in patients with meningioma were also published; the purpose of these recommendations was to provide clear instructions on technical parameters, indications for use and interpretation of the PET/CT results obtained in neurooncology, with a clear understanding of the possibilities and limitations and, ultimately, clear algorithms for this examination method.

Patients with metastatic castration-resistant prostate cancer (mCRPC) are a complex and heterogeneous group, and the main goal of their treatment includes both increase in life expectancy and maintenance of its quality. The most common localization of metastasis of prostate cancer (PCa) is the bones of the skeleton, which is associated with a high risk of skeletal complications and implies difficulties to further treatment of this group of patients. The increase in the incidence of prostate cancer requires the search for new methods of treatment for this category of patients. Currently, there are several therapeutic options for the treatment of mCRPCa: chemotherapy, androgen receptor signaling inhibitors, systemic alpha-radiotherapy. Radium chloride [Ra223] is the first alpha-emitting radiopharmaceutical (RP) approved for the treatment of CRPC patients with bone metastases and the first RP improving overall patient survival. The study was aimed to the evaluation of the efficacy and safety of Ra223 in patients with mCRPC. This analysis included 54 patients with mCRPCa who received 1 to 6 injections of radium-223 [Ra-223] as part of routine clinical practice. Most patients had more than 6 metastases - 92.6%; 4 patients had less than 6 metastases - 7.4%. Radium-223 [Ra223] has been shown to be effective in patients with mCRPCa. The maximum effect of therapy was observed in patients who received 5 or more injections. At the same time, there was a good tolerability of the drug and a low level of toxicity.

Dual HER2 blockade with pertuzumab + trastuzumab has been standard treatment for early and metastatic HER2 positive breast cancer (BC) for several years. The recent registration of a fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection opens up new perspectives for physicians and patients. The article discusses the role of dual targeted HER2 blockade in the complex treatment of patients with HER2 positive BC. The article provides an overview of data from key studies that have identified the place of the combination of pertuzumab+trastuzumab in modern algorithms for the treatment of HER2-positive BC. The data from studies of a fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection and the potential advantages of the new drug over intravenous pertuzumab and trastuzumab in the management of patients with HER2 positive BC are discussed.

Background. Using modern chemotherapy regimens, elements of aggressive oncosurgery in gynecological oncology, it is possible to achieve an increase in the number of cured patients with locally advanced cervical cancer (CC), providing an improvement in the immediate and long-term results of treatment. The proposed method of surgical treatment is the method of choice for the surgical treatment of patients with locally advanced cervical cancer (IIA-IIIB stage). Objective. Introduction of the method of surgical treatment of IIA - IIIB stage cervical cancer into clinical practice. Methods. Long-term results of treatment of 155 patients with morphologically verified IIA - IIIB stage cervical cancer were analyzed. Patients received neoadjuvant chemotherapy (NACT) (n=110) and chemoradiation therapy (CRT) (n=45). After achievement of resectability, the patients underwent surgical treatment using a new technique. Overall survival (OS) and progression-free survival (PFS) outcomes were assessed. Results. In the period from 2017 to 2020, 155 patients with IIA - IIIB stage cervical cancer after NACT (n=110) and CRT (n=45) underwent combined radical hysterectomy according to our patented method. The most frequent postoperative complications were urinary disorders in 67(60.9%) and 19 (42.2%) patients, lymphatic cysts in 20 (18.2%) and 10 (22.2%) and vesicovaginal fistula in 5 (4.6%) and 2 (4.4%) patients, respectively. According to the results of pathomorphological examination, the most frequent tumor response to NACT was grade III therapeutic pathomorphosis (TP) in 44 patients (40%) of group 1 and grade IV TP in 21 patients, accounting for 46.6%. The median follow-up was 28.7 (3.6 to 51.1) months. During this time, 30 patients died in both groups (17 [15.5%] and 13 [28.9%]), (P=0.047). Disease progression occurred in 16 (10.3%) patients (6 [5.5%] and 10 [22.2%]) (P=0.004), respectively. The 3-year OS was 83.8±3.7and 71.0±6.8% (P=0.131), PFS - 93.5±2.6and 77.7±6.6% (P=0.006). Conclusion. The proposed method of surgical treatment of IIA - IIIB stage cervical cancer has a novelty and can be used in practical medicine for surgical treatment of cervical cancer.

Medications errors (ME) can significantly worsen patient’s prognosis, heavy harm to health, increase mortality rates, and be a prominent risk factor for the development of drug-induced diseases. Approximately one third of adverse drug reactions are associated with ME during drug therapy. ME may occur at different levels of the pharmacotherapy involving prescribing, transcribing, dispensing, administering, monitoring as well as during medication production, storage, and preparation for use. Studies suggests that ME associated with certain factors such as information relating to the history of the patient’s disease; medications themselves; communication between heath care specialists in order to transfer information about dug; drug classification, naming and labeling; storage, preservation and standardization of drugs; attainment, using and monitoring devices for receiving drugs; environmental factors; competence and education of medical personnel and patient; monitoring of the safety profile and risks of pharmacotherapy. Due to the exceptional importance of ME in the development of drug-induced adverse condition and complication, various interventions to prevent and minimize such errors are being developed and tested in practice. These approaches include pharmacist-led medication reconciliation, computerized medication reconciliation, computerized physician order entry with or without clinical decision support system, partnership cooperation with pharmacists and interdisciplinary collaboration, training of doctors and patients, involving trained medication experts, an automated drug distribution system, the use of electronic administration system and methods for facilitating distribution of drugs to patients. Based on the analysis of available literature, it can be concluded that further active research and practical work is needed to minimize the prevalence of ME in view of their principal role in the aspects of the pharmacotherapy safety.

Background. The therapeutic capabilities for the treatment of hormone receptor-positive (HR+), HER2-negative (HER2-) metastatic breast cancer (mBC) have significantly increased after the introduction of new drugs for hormone therapy and their combinations with targeted drugs into clinical practice. The article discusses some key issues related to the use of new diagnostic methods, treatment and their potential impact on the choice of drug therapy regimen for hormone receptor-positive (HR+), HER2-negative (HER2-) metastatic breast cancer (mBC). Description of the clinical case. The article analyzes the clinical case of a patient with luminal type of breast cancer who had not previously received adjuvant hormone therapy. 4 years after the completion of the combination therapy of the primary tumor, multiple bone metastases without metastatic lesions of other systems and organs were detected. In accordance with the treatment plan, the patient received fulvestrant in first-line therapy for 8 years; it was discontinued due to the progression of the disease, and the second-line therapy with palbociclib + letrozole was recommended. The results of the genetic study were obtained one month before the patient’s death. Conclusion. With the timely obtainment of data on the biological subtype of the tumor, genetic testing, it is likely that other drug regimens with higher expected efficacy would have been prescribed. Today, molecular genetic testing of a patient’s tumor sample is becoming increasingly available. However, for a timely and urgent testing, it is necessary to improve the logistics and routing of the delivery of biosamples of patients, and the preparation of accompanying documentation.

Background. Wilm’s tumor, or nephroblastoma, is one of the most common solid malignant neoplasms in children, occurring almost exclusively in the kidneys. Extrarenal Wilm’s tumors are extremely rare, and their clinical presentation depends on the location of the tumor. The diagnosis of extrarenal Wilm’s tumor is almost always made after resection and histological evaluation of the tumor. Description of the clinical case. The article presents the case of a 10-year-old boy with an extrarenal Wilm’s tumor located in the retroperitoneal space. He applied to the local outpatient clinic with complaints of abdominal pain, an increase in the abdomen in volume. According to the ultrasound examination of the abdominal organs, the formation of the retroperitoneal space was revealed. In Tashkent City Branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology, magnetic resonance imaging of the abdominal organs with intravenous contrast was performed. In the projection of the right kidney, a round formation with the size of 11x11x15 cm was revealed. The patient underwent a high-tech operation from the point of view of oncosurgery and reconstructive surgery. In the postoperative period, the tumor was classified as intermediate risk stage III (invasion of the tumor beyond the capsule with a positive para-aortic lymph node). Adjuvant chemotherapy was performed after surgical treatment. The total duration of treatment was 5 months. The patient is under observation. The duration of remission is 8 months. Conclusion. It is appropriate to assume the extrarenal Wilm’s tumor when evaluating patients with asymptomatic abdominal distension, since an untimely diagnosis may delay appropriate therapy.